MEDICARE: HO JUN KIM LIC. ACU.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AC11071	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AC 11071	OTHER	CA	ACUPUNCTURE LICENSE

General Provider Information

NPI Number	:	1891972519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HO JUN KIM LIC. ACU.

Provider Business Mailing Address
First Line	:	1121 S 4TH ST
Second Line	:	SUITE A
City	:	EL CENTRO
State	:	CA
Zip	:	92243-4742
Country	:	US
Telephone Number	:	760-370-0516
Fax Number	:

Provider Business Practice Location Address
First Line	:	1121 S 4TH ST
Second Line	:	SUITE A
City	:	EL CENTRO
State	:	CA
Zip	:	92243-4742
Country	:	US
Telephone Number	:	760-370-0516
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2008
Last Update Date	:	01/24/2008

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